Provider Demographics
NPI:1245890631
Name:CROUCH, BETH (DNP, APRN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:CROUCH
Suffix:
Gender:F
Credentials:DNP, APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 REDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BLUFF CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37618-1522
Mailing Address - Country:US
Mailing Address - Phone:423-366-3635
Mailing Address - Fax:
Practice Address - Street 1:110 W SPRINGBROOK DR STE A
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1701
Practice Address - Country:US
Practice Address - Phone:423-929-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24266363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care